Can a West Virginia county ambulance authority delegate ambulance-allocation decisions to a subcommittee of its board, and can the squads use private companies to bill patients?
Official title
Opinion of the Attorney General's Office (Second Opinion) Regarding Whether a County Ambulance Authority's Practices Comply with the Emergency Ambulance Service Act of 1975
Plain-English summary
A follow-on opinion to the AG's July 8, 2014 letter on Mineral County Ambulance Authority practices. Two questions remained.
First, could a "secondary board within the board," a kind of executive subcommittee, make decisions about ambulance placement and major equipment repairs or replacements without putting them to the full board? The AG said no. The statute lodges management in a board of five to fifteen members, gives every member one vote on all matters, and requires regular meetings to be "general meetings for the consideration of any and all matters." A subcommittee acting on its own contradicted that structure. Authorities have wide discretion over their physical assets, but exercising that discretion through a subset of members rather than the full board is not what the Act allows.
Second, could the authority's individual squads use private companies to bill patients for services? The AG said yes. W. Va. Code § 7-15-10(d) lets an authority "employ, in its discretion, planning consultants, attorneys, accountants, superintendents, managers and such other employees and agents as may be necessary," and lets the authority enter contracts for "superintendence and management services." A billing vendor falls within those categories. The catchall power in § 7-15-10(l) to "do all things necessary and convenient" reinforced that conclusion, subject to the conflict-of-interest rules in § 7-15-15.
Currency note
This opinion was issued in 2014. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.
Common questions
Q: What is a "secondary board within the board"?
A: It refers to an executive committee or smaller working group of board members who would make decisions on a specified set of issues (here, ambulance placement and major equipment) without the full board voting. Many private organizations operate this way for efficiency. The AG read the Emergency Ambulance Service Act to require the full board to act on all authority business, which made that structure problematic.
Q: Why does the law require the full board to vote on these decisions?
A: W. Va. Code § 7-15-5 says management is "lodged in a board of not less than five nor more than fifteen individuals" and that each member has "one vote on all matters coming before it." § 7-15-7 says regular meetings are "general meetings for the consideration of any and all matters which may properly come before an authority." Read together, the AG concluded the legislature intended the full board to participate in every authority-level decision.
Q: Can the board delegate routine work, or does every detail need a board vote?
A: The opinion is about decisions that traditionally belong to a governing board (where ambulances are stationed, what gets repaired or replaced). The AG did not say staff cannot make day-to-day operational calls. The line is at decisions affecting the authority's strategic deployment of its property, which the statute treats as board-level matters.
Q: What is the practical effect of using a private billing company?
A: The squad continues to render services and the billing company sends statements, follows up on claims, and handles collections. The AG's earlier July 8, 2014 opinion explained that an authority "may impose and collect fees and charges upon users of their services for services rendered" under § 7-15-10. The second opinion confirmed the authority can retain a vendor to handle the back-office side of that.
Q: Are there limits on which billing companies an authority can use?
A: The authority must comply with the conflict-of-interest provisions in § 7-15-15. Beyond that, the Act does not specify procurement procedures for service contracts of that type. Note that § 7-15-16 (not directly addressed in this opinion) does require competitive bidding for purchases of supplies, equipment, and materials over $10,000; that procurement rule is most relevant when an authority is buying physical goods rather than retaining a service provider.
Q: This opinion came out a month after another opinion to the same prosecutor. Why two?
A: The AG's July 8, 2014 opinion answered six questions about the Mineral County Ambulance Authority's practices. The prosecutor sent two more questions afterward (the subcommittee structure and the billing vendor question), which became this second opinion.
Background and statutory framework
The Emergency Ambulance Service Act of 1975, W. Va. Code §§ 7-15-1 et seq., authorizes county commissions to create public corporations to provide ambulance service. Those authorities are governed by boards appointed by the participating governments.
W. Va. Code § 7-15-5 ("The management and control of an authority, its operations, business and affairs shall be lodged in a board of not less than five nor more than fifteen individuals") sets the foundational governance rule. The same section gives each member "one vote on all matters coming before it." § 7-15-7 establishes that regular meetings are general meetings for all matters and that special meetings require notice to "all the members" of the time, place, and matters to be considered.
The AG read those provisions together: the legislature contemplated that authority-level decisions would be made by the full board, voting in person, with notice to every member. A subcommittee that bypassed the board on substantive decisions about ambulance allocation and major repairs would not fit that structure.
On billing, § 7-15-10 lists the authority's powers. Subsection (d) covers retention of "planning consultants, attorneys, accountants, superintendents, managers and such other employees and agents as may be necessary in its judgment," and authorizes "contracts and agreements for superintendence and management services." Subsection (l) is the catchall that authorities may "do all things necessary and convenient to carry out the powers given in this article unless otherwise forbidden by law." A third-party billing vendor fits under (d), and the catchall reinforces it.
Conflict-of-interest restrictions in § 7-15-15 still apply: members and officers cannot have undisclosed financial interests in vendors. Beyond that, the Act left a wide discretion to the authority on procurement of service vendors.
Citations
- W. Va. Code § 5-3-2 (AG advisory authority)
- W. Va. Code §§ 7-15-1 et seq. (Emergency Ambulance Service Act)
- W. Va. Code § 7-15-5 (board management, one-member-one-vote)
- W. Va. Code § 7-15-7 (regular and special meetings)
- W. Va. Code § 7-15-10(d), (l) (powers, employees and agents, catchall)
- W. Va. Code § 7-15-15 (conflicts of interest)
- Opinion of the Attorney General's Office Regarding Whether a County Ambulance Authority's Practices Comply with the Emergency Ambulance Service Act of 1975 (July 8, 2014)
Source
- Landing page: https://ago.wv.gov/media/18056/download?inline
- Original PDF: https://ago.wv.gov/media/18056/download?inline
Original opinion text
State of West Virginia
Office of the Attorney General
Patrick Morrisey
Attorney General
(304) 558-2021
Fax (304) 558-0140
August 25, 2014
The Honorable James W. Courrier, Jr.
Prosecuting Attorney
Mineral County
P.O. Drawer 458
Keyser, WV 26726
Dear Prosecutor Courrier,
You have asked for a second Opinion of the Attorney General about whether the Mineral County Ambulance Authority's practices comply with the Emergency Ambulance Service Act of 1975, W. Va. Code § 17-15-1 et seq. (the "Act"). This Opinion is being issued pursuant to West Virginia Code § 5-3-2, which provides that the Attorney General "may consult with and advise the several prosecuting attorneys in matters relating to the official duties of their office." To the extent this Opinion relies on facts, it is based solely on the factual assertions set forth in your recent correspondences with the Office of the Attorney General.
According to your letters, Mineral County Commissioner Richard Lechliter has been discussing with you the prospect of revising the by-laws of the Mineral County Ambulance Authority. Your initial letter, to which we responded with a formal Opinion on July 8, 2014, sought advice from this Office regarding a wide-ranging series of questions raised to you by Commissioner Lechliter. The most recent letter, which is the subject of this Opinion, seeks advice regarding two follow-up questions posed to you by the Commissioner. We hope that we have been able to provide you the guidance you require to be responsive to the Commissioner.
You letter raises two legal issues, which are addressed in turn below:
(1) May an ambulance authority form a "secondary Board within the Board" to make decisions about the placement of new ambulances and major repairs or replacement of equipment on individual ambulances?
(2) May ambulance authority squads use private billing companies to charge users for services rendered?
As in our previous Opinion, this Opinion focuses only on the application of and compliance with the Act. We do not address compliance with other aspects of West Virginia law, including other statutes or any applicable agency regulations.
Question One: May an Ambulance Authority Form a "Secondary Board Within the Board" to Make Decisions About the Placement of New Ambulances and Major Repairs or Replacement of Equipment on Individual Ambulances?
An ambulance authority has broad discretion over the personal property it owns and uses for the purpose of providing emergency ambulance service. As we previously noted, "no provision of the Act places any restrictions on how an authority is to select, allocate, replace, or mark its ambulances, so long as the authority continues to effectively fulfill its mission." Opinion of the Attorney General's Office Regarding Whether a County Ambulance Authority's Practices Comply with the Emergency Ambulance Service Act of 1975, W. Va. Code § 7-15-1 et seq. (July 8, 2014), at 6-7, available at http://www.ago.wv.gov/publicresources/Attorney%20General%20Opinions/Pages/default.aspx. We read the Act "to grant ambulance authorities a wide berth with respect to the ownership and management of personal property, including ambulances." Id. at 6.
The Act suggests, however, that the authority's discretion is entrusted to the board as a whole. "The management and control of an authority, its operations, business and affairs shall be lodged in a board of not less than five nor more than fifteen individuals." W. Va. Code § 7-15-5 (emphasis added). Furthermore, each "member of the board shall have one vote on all matters coming before it." Id. (emphasis added). Consistent with that, "[a]ll regular meetings shall be general meetings for the consideration of any and all matters which may properly come before an authority." Id. § 7-15-7. For any special meeting, notice of the time, place, and matters to be considered must be specifically provided to "all the members." Id. (emphasis added). We believe these provisions of the Act clearly contemplate that the board as a whole, with each member having the opportunity to participate and vote, must act on "any and all matters" concerning the authority, including any decisions concerning ambulances.
Question Two: May Ambulance Authority Squads Use Private Billing Companies to Charge Users for Services Rendered?
The Act permits an ambulance authority to use a billing provider. We previously based this conclusion on two provisions in the Act. First, an authority may "employ, in its discretion, planning consultants, attorneys, accountants, superintendents, managers and such other employees and agents as may be necessary in its judgment and fix their compensation." Id. § 7-15-10(d). Second, an authority may "enter into contracts and agreements for superintendence and management services." Id.
In general, an ambulance authority appears to have wide latitude to choose the manner and methods of fulfilling its mission. The Act specifically provides an authority the ability to "do all things necessary and convenient to carry out the powers given in this article unless otherwise forbidden by law." Id. § 7-15-10(l). Together with the provisions cited immediately above, it seems clear that the Legislature intended for an ambulance authority to have significant discretion to delegate responsibilities as necessary, subject to certain conflict of interest provisions. See, e.g., id. § 7-15-15.
Sincerely,
Patrick Morrisey
Attorney General
Elbert Lin
Solicitor General
Steven Travis
Assistant Attorney General